Organization
OAK GROVE PHARMACY INC
Active
Organization
OAK GROVE PHARMACY INC
Active
Other names
Oak Grove Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB HYATT (PHARMACIST/OWNER)
(501) 851-3636
Entity
Organization
Contact information
Practice address
11114 MAC ARTHUR DR, NORTH LITTLE ROCK, AR 72118-1854
(501) 851-3636
(501) 851-3640
Mailing address
11114 MAC ARTHUR DR, NORTH LITTLE ROCK, AR 72118-1854
(501) 851-3636
(501) 851-3640
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR10174
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100524407
—
AR
01
—
2125605
PK
—
Enumeration date
12/13/2005
Last updated
01/06/2021
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